The Future Leaders Awards program is brought to you in partnership with Homecare Homebase. The program is designed to recognize up-and-coming industry members who are shaping the next decade of home health, hospice care, senior housing, skilled nursing, and behavioral health. To see this year’s Future Leaders, visit https://futureleaders.agingmedia.com/.
Ethan McChesney, policy director, National Partnership for Healthcare and Hospice Innovation (NPHI), has been named a 2023 Future Leader by Hospice News.
To become a Future Leader, an individual is nominated by their peers. The candidate must be a high-performing employee who is 40-years-old or younger, a passionate worker who knows how to put vision into action, and an advocate for seniors and the committed professionals who ensure their well-being.
McChesney sat down with Hospice News to talk about his career trajectory and the ways the industry is evolving.
What drew you to the hospice and palliative care industry?
I knew for quite some time that health care policy was an issue I was particularly interested in. I attribute that in part to a diagnosis at birth of a congenital heart defect and simultaneously my mom, who has worked at a large health system in Kansas City. So, this kind of set me on the path towards being immersed in health related issues from a young age, both personally and indirectly.
I really came to quickly learn the immense opportunity to really help create positive system change if you focus your energy on the elements of the health care system that are providing high quality, cost effective care.
Hospices are among the providers that are under a threat from an evolving policy and competition in the landscape. And that’s one of the reasons I was drawn into it really, because of the opportunity of change there.
It’s also just having this innate sense of fulfillment you get from supporting providers that care for folks at the end of life who are really going through probably their most vulnerable and difficult moments.
What’s your biggest lesson learned since starting to work in this industry?
So far during my time in health policy, I’ve learned quite a bit about the issues in hospice and the advocacy efforts and strategies to address them. I’m the first to admit that I fell victim to a lot of the common assumptions and misconceptions about the value and purpose of hospice when I first entered the space. It was this idea of care that is only for people at the very end of life.
My biggest and most fulfilling lesson was realizing that it’s something that can be further upstream, coming to understand the value hospice provides much sooner than that. I really have developed an appreciation for how hospice provides a comprehensive suite of services to both the patient and their family.
Providers of those services and the patients they care for can really benefit from a model of advanced illness care well before the final moments. It can be weeks, months, or years before death and an interdisciplinary palliative or home care program can be a great transition to hospice.
I think that knowledge has sort of fueled my career path in understanding the implications of focusing on the aging care policy space. There is so much more to aging than just hospice, including implications around palliative and primary care and just a wider breadth of policy issues than those just directly related to the Medicare Hospice Benefit.
If you could change one thing with an eye toward the future of hospice and palliative care, what would it be?
A big thing I would change is the core structure of the Medicare Hospice Benefit. We’re spending a lot of time and working hard to really re-envision what the hospice benefit looks like, and position those who provide it for long-term sustainability.
The benefit has been in place now for basically four decades without substantial modifications, except for some regulatory changes implemented here and there. It’s well past the time to update the eligibility determination process and the payment methodology in the hospice benefit to better align reimbursement with high quality care.
We can do a better job of tying actual patient needs to payment, as opposed to relying on subjective judgments of clinical eligibility that are really so fraught with opportunity for bad actors to come in and manipulate the benefit for their own gain. There’s certainly not a short-term fix, but I think there is a growing recognition among the different stakeholders in the space that it is time to make some significant modifications to the benefit.
As far as modifications, the hospice eligibility process is probably the easiest for policymakers and regulators to understand. When the benefit was created, it was primarily for cancer patients and it made a lot of sense that you would judge a patient’s prognosis to death as their illness ran its normal course. The vast majority of cancer patients fall within that window of that six-month prognosis. Now, at least one-third of hospice patients have neurodegenerative diseases such as dementia and Alzheimer’s and that prognosis to death is much more difficult to determine, often with other comorbidities occurring.
It’s time to bring it up to speed with the realities of how hospice is provided, and who is accessing the benefit. We need to keep pace with that.
What do you foresee as being different about hospice and palliative care looking ahead to 2024?
There has been growing focus on program integrity concerns in hospice, and I would really expect it to remain top of mind as well-meaning providers and industry organizations look to continue to eliminate opportunities for fraud, waste, and abuse in this benefit.
I think regulators really caught on in the last year about the breadth of this problem and instances in which some were profiteering with outright fraud of multiple hospices at the same address, or cherry-picking certain patients with disproportionately longer stays and higher costs. That’s the behavior that CMS has really honed in on and will continue growing that focus into 2024.
We’ll [also] see a continued evolution of the marketplace in which hospices are operating. What’s driving change now and into the next few years as Medicare Advantage (MA) becomes a larger player in this benefit through the [value-based insurance design (VBID)] demonstration is that the traditional hospice payer mix will eventually evolve to include others besides Medicare fee-for-service and MA beneficiaries.
Should the hospice carve-in become permanent, then there’s going to be changes to help providers learn how to work with new payers and vice versa, to help payers learn to understand hospice and the value that it provides.
In a word, how would you describe the future of hospice and palliative care?
There are so many opportunities to create and support innovation in hospice, whether that be new lines of business further upstream or new care models, or with new partnerships or organization affiliations. It’s having that innovative spirit that will hopefully continue to be at the forefront of where the industry is headed.
Community-based hospices are increasingly seeing the writing on the wall — better to get moving and start your own course than get left behind.
If you could give advice to yourself looking back to your first day in the industry, what would it be and why?
A piece of advice I could have benefited from early on and still now need to remind myself about is that it never hurts to just introduce yourself. You never know who might have the best case for an issue, or who might say something in a way you hadn’t considered. The more relationships I’ve created in the hospice and palliative care community, the more I’ve learned from people who have given me a nugget of something that I didn’t anticipate or even ask about.
I would also encourage my younger self to speak up even when it’s uncomfortable, because its’ about representing care for folks at the end of life, and that is incredibly challenging, rewarding work.The least we can do as advocates is a stand up for their perspective and unique viewpoint. Realize the importance of the voice you have in this space.
To learn more about the Future Leaders program, visit https://futureleaders.agingmedia.com/.